Resp Care
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Oxygen use in prehospital care is aimed at treating or preventing hypoxemia. However, excess oxygen delivery has important consequences in select patients, and hyperoxia can adversely impact outcome. ⋯ Oxygen therapy in prehospital care should be provided to patients with hypoxemia and titrated to achieve normoxemia. Changes to the current practice of oxygen delivery in prehospital care are needed.
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Home oxygen therapy equipment options have increased over the past several decades, in response to innovations in technology, economic pressure from third-party payers, and patient demands. The delivery of oxygen in the home has evolved from packaged gas systems containing 99% United States Pharmacopeia oxygen provided by continuous-flow delivery to intermittent-flow delivery, with oxygen concentrators delivering < 99% oxygen purity. The majority of published papers indicating the value of long-term oxygen therapy have been based on continuous-flow delivery of 99% United States Pharmacopeia oxygen. ⋯ New standards of care are required to address the need to have consistent titration of long-term oxygen therapy to meet the patient's home needs at all activity levels. Consistent labeling of metering devices on home oxygen equipment will need to be developed by professional medical societies to be implemented by standards organizations that direct industrial manufacturers. Home oxygen therapy will need professionally trained respiratory therapists reimbursed for skills and service to ensure that patients receive optimal benefits from home oxygen equipment to improve patient outcomes and prevent complications and associated costs.
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The history of oxygen from discovery to clinical application for patients with chronic lung disease represents a long and storied journey. Within a relatively short period, early investigators not only discovered oxygen but also recognized its importance to life and its role in respiration. The application of oxygen to chronic lung disease, however, took several centuries. ⋯ It took brazen clinicians, however, to pursue oxygen as a therapeutic resource for patients with chronic lung disease because of the concern in the 20th century of the risks of oxygen toxicity. Application of ambulatory oxygen devices allowed landmark investigations of the long-term effects of continuous oxygen that established its safety and efficacy. Although now well established for hypoxic patients, many questions remain regarding the benefits of oxygen for varying severity and types of chronic lung disease.
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While pressurized oxygen in tank form, as well as oxygen concentrators, are ubiquitous in civilian healthcare in developed countries for medical use, there are a number of settings where use of these oxygen delivery platforms is problematic. These settings include but are not limited to combat casualty care and healthcare provided in extreme rural environments in undeveloped countries. ⋯ This paper provides a brief overview of the previous and current attempts to utilize chemical oxygen production strategies to enhance systemic oxygenation. While promising, the routine use of chemically produced oxygen continues to pose significant engineering and physiologic challenges.